Predictors of thrombus formation after percutaneous left atrial appendage closure using the WATCHMAN device

Percutaneous left atrial appendage (LAA) closure using the WATCHMAN device is a novel option for prevention of stroke associated with atrial fibrillation. However, device-related thrombus (DRT) formation is a concern after WATCHMAN implantation and the predictors of DRT still remain unclear. We aime...

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Bibliographic Details
Published in:Heart and vessels 2017-09, Vol.32 (9), p.1137-1143
Main Authors: Kaneko, Hidehiro, Neuss, Michael, Weissenborn, Jens, Butter, Christian
Format: Article
Language:English
Subjects:
Anticoagulants
Biomedical Engineering and Bioengineering
Blood clots
Cardiac Surgery
Cardiology
Fibrillation
Implantation
Kidney transplantation
Males
Medicine
Medicine & Public Health
Original Article
Patients
Regression analysis
Stroke
Thrombosis
Vascular Surgery
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Summary:Percutaneous left atrial appendage (LAA) closure using the WATCHMAN device is a novel option for prevention of stroke associated with atrial fibrillation. However, device-related thrombus (DRT) formation is a concern after WATCHMAN implantation and the predictors of DRT still remain unclear. We aimed to clarify the predictors of DRT after WATCHMAN implantation by analyzing 78 patients (50 males, 72 ± 8 years, average CHA2DS2-VASc score of 4.3 + 1.8) who had undergone WATCHMAN implantation. WATCHMAN was successfully implanted in all patients and four (5%) developed DRT. Patients with DRT were more often female (75 vs. 34%, p  = 0.094). CHA2DS2-VASc score was higher for patients with DRT (6.3 ± 2.5 vs. 4.2 ± 1.7, p  = 0.022). Chronic kidney disease (100% vs. 43%, p  = 0.024) and deep implantation of the device, which was defined as implant position below the LAA ostial plane (75 vs. 24%, p  = 0.026), were more common in patients with DRT. HAS-BLED score (4.5 ± 1.0 vs. 3.5 ± 1.1, p  = 0.074) was higher and oral anticoagulants (50 vs. 84%, p  = 0.086) were less commonly prescribed for patients with DRT. Multivariable logistic regression analysis showed that higher CHA2DS2-VASc score ( p  = 0.022, OR 2.8) and deep implantation ( p  = 0.032, OR 24.7) were associated with DRT. These results suggest the possible role of CHA2S2-VASc scores and implantation depth in the development of DRT after percutaneous LAA closure using the WATCHMAN device.
ISSN:0910-8327
1615-2573
DOI:10.1007/s00380-017-0971-x